Healthcare Provider Details

I. General information

NPI: 1619151230
Provider Name (Legal Business Name): JULIE BURNS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

POB 146 47 STEWART AVENUE MEDICINE SHOPPE PHARMACY
ROSCOE NY
12776
US

IV. Provider business mailing address

47 STEWART AVE POB 146
ROSCOE NY
12776-5105
US

V. Phone/Fax

Practice location:
  • Phone: 607-498-4111
  • Fax: 607-498-4117
Mailing address:
  • Phone: 607-498-4111
  • Fax: 607-498-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number034797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: